临床资料患者女性,42岁.因“发热、咳嗽10+d”入院.患者于2020年1月3日出现乏力,无明显咳嗽咯痰,胸部X线片未见明显异常(图1),服用“感冒药”后症状无明显缓解,1月6出现高热(最高39.9℃),查胸部CT提示双肺多发斑片影,胸膜下明显(图2a),同时逐渐出现干咳及呼吸困难.1月8日收入当地某三甲医院,考虑“新型冠状病毒肺炎”,予以糖皮质激素和无创呼吸机治疗.

BACKGROUND:Effective auscultations are often hard to implement in isolation wards. To date, little is known about the characteristics of pulmonary auscultation in novel coronavirus (COVID-19) pneumonia.OBJECTIVES:The aim of this study was to explore the features and clinical significance of pulmonary auscultation in COVID-19 pneumonia using an electronic stethoscope in isolation wards.METHODS:This cross-sectional, observational study was conducted among patients with laboratory-confirmed COVID-19 at Wuhan Red-Cross Hospital during the period from January 27, 2020, to February 12, 2020. Standard auscultation with an electronic stethoscope was performed and electronic recordings of breath sounds were analyzed.RESULTS:Fifty-seven patients with average age of 60.6 years were enrolled. The most common symptoms were cough (73.7%) during auscultation. Most cases had bilateral lesions (96.4%) such as multiple ground-glass opacities (69.1%) and fibrous stripes (21.8%). High-quality auscultation recordings (98.8%) were obtained, and coarse breath sounds, wheezes, coarse crackles, fine crackles, and Velcro crackles were identified. Most cases had normal breath sounds in upper lungs, but the proportions of abnormal breath sounds increased in the basal fields where Velcro crackles were more commonly identified at the posterior chest. The presence of fine and coarse crackles detected 33/39 patients with ground-glass opacities (sensitivity 84.6% and specificity 12.5%) and 8/9 patients with consolidation (sensitivity 88.9% and specificity 15.2%), while the presence of Velcro crackles identified 16/39 patients with ground-glass opacities (sensitivity 41% and specificity 81.3%).CONCLUSIONS:The abnormal breath sounds in COVID-19 pneumonia had some consistent distributive characteristics and to some extent correlated with the radiologic features. Such evidence suggests that electronic auscultation is useful to aid diagnosis and timely management of the disease. Further studies are indicated to validate the accuracy and potential clinical benefit of auscultation in detecting pulmonary abnormalities in COVID-19 infection.

此次呼吸道新型冠状病毒感染,特别是新型冠状病毒肺炎,对我国造成巨大影响.截至2020年2月22日,确诊患者76 392例,死亡2 348例.我们对这些不幸离世同胞表示深切的哀悼!

新型冠状病毒肺炎的诊断不仅要重视病毒核酸检测,还应结合病史、影像学等临床信息综合判断,同时要甄别容易进展为危重症的患者.在治疗上,要根据患者的基础疾病及肺炎进展速度分层、个体化治疗.重症患者需加强呼吸支持、营养支持,部分患者可给予激素治疗.

此次新型冠状病毒疫情发生以来,造成了大量人员感染,截至2020年2月4日,确诊病例达到20 520例.部分患者发生严重急性呼吸道感染(severe acute respiratory infection,SARI),也有部分患者出现呼吸衰竭等并发症,还有部分患者死亡,成为当前我国甚至全球卫生系统面临的一个最大挑战.作为一个新发传染性强的呼吸道感染疾病,由于最初诊断的患者均为肺炎,所以目前统一采用新型冠状病毒感染的肺炎.随着疫情的发展,我们对这个疾病有了越来越多的认识,包括人际传播、无症状患者、核酸检测敏感性问题、CT影像的特征及在新型冠状病毒肺炎筛查中的地位.